When to worry about vertigo with migraine

Migraine-related vertigo may feel like spinning, rocking, or being pulled off balance. It can happen with a headache, light sensitivity, sound sensitivity, nausea, or visual symptoms, but some attacks have little or no head pain. The sensation may come in episodes and can leave you tired or unsteady afterward.

A familiar pattern that settles with your usual migraine plan is less concerning than a first episode or a marked change. Vertigo has other possible causes, including inner-ear disorders and problems affecting the nervous system, so the pattern and associated symptoms matter.

Sit or lie somewhere safe, avoid driving, and move your head slowly. Reduce bright light and noise if they trigger symptoms. Sip fluids if you can keep them down, and use prescribed migraine medicine according to your clinician’s instructions. Note when the vertigo began, how long it lasted, what you felt with it, and whether the episode matched earlier attacks.

Seek emergency help for vertigo with trouble speaking, facial drooping, one-sided weakness or numbness, fainting, a new severe headache, chest pain, difficulty walking, new hearing loss, or persistent vomiting. Seek prompt medical review for a first episode, symptoms that are steadily worsening, an attack after a head injury, or vertigo that does not follow your usual migraine pattern.

Could this pattern fit vestibular migraine, or should my ears, medicines, and nervous system be checked? Which symptoms mean I should go straight to emergency care? What should I record during future episodes, and which treatments are suitable for me?